COMMENTARY

Is Venous Thromboembolism a Chronic Condition?

Samuel Z. Goldhaber, MD

Disclosures

October 07, 2014

This feature requires the newest version of Flash. You can download it here.

Hello. This is Dr Sam Goldhaber, for the Clot Blog at theheart.org on Medscape, speaking to you from the European Society of Cardiology meetings in Barcelona. Today I will speak about the implications of a first-time venous thromboembolism (VTE) event and the implications over the ensuing 30 years from an epidemiologic perspective. I will highlight a Danish population cohort study[1] in which patients who developed VTE, either a deep vein thrombosis (DVT) or pulmonary embolism (PE), were tracked over the next 30 years in Denmark and compared with the general population.

We have tended to think of PE and DVT as one-time events that can be managed with 3, 6, or 12 months of anticoagulation and then, more or less, be cast aside without any long-term increased risk. This Danish epidemiologic study brings this concept into question and makes us reframe the presence of a VTE as a long-term chronic condition that the patient, the family, and the healthcare providers need to confront and deal with on a lifelong basis. In this study, patients who had a DVT over the ensuing 30 years were at approximately 50% increased risk of dying compared with the general population cohort matched by age and sex. Those who originally had a PE and were tracked over the next 30 years were at approximately 2.5 times increased risk of dying during that time period compared with age- and sex-matched controls from the general population.

Why might this be? For most people, VTE is a chronic inflammatory condition, like coronary disease or diabetes, and it has to be dealt with over a lifetime. Whether anticoagulants should be stopped after 3, 6, or 12 months might be open to question and further research because dying from PE or DVT was a major cause of death in this population that was tracked over the next 30 years. The individuals who suffered an initial single event of VTE were at greatly increased risk for death from cardiovascular illness, including myocardial infarction and stroke. There was an increased risk of dying from cancer as well.

This Danish study gives us a cautionary yellow light that we can't blindly reassure our patients that their lives are going to return entirely to normal. They have to be working overtime to reduce their risk for cardiovascular disease to counter some of these epidemiologic trends. This is Dr Sam Goldhaber, signing off for the Clog Blog.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....